Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS Cardio-Oncology clinic.

Abstract

Abstract Background Following the publication of international cardio-oncology (CO) imaging guidelines, standard echocardiographic monitoring parameters of left ventricular systolic function have been endorsed. Recommendations highlight that either two-dimensional (2D) or three-dimensional (3D) left ventricular ejection fraction (LVEF), alongside global longitudinal strain (GLS) should be routinely performed for surveillance of patients at risk of cancer therapy-related cardiac dysfunction (CTRCD). We studied the feasibility of 3D-LVEF, 2D GLS and 2D LVEF in a dedicated CO service. Methods This was a single-centre prospective analysis of consecutive all-comer patients (n = 105) referred to an NHS CO clinic. Using a dedicated Philips EPIQ CVx v7.0, with X5-1 3D-transducer and 3DQA software, we sought to acquire and analyse 2D- and 3D- LVEF and GLS, adhering to the British Society of Echocardiography (BSE) CO transthoracic echocardiography protocol. Results A total of 105 patients were enrolled in the study; 24 were excluded due to poor echo windows with poor endocardial definition (n = 19) or carcinoid heart disease (n = 5). Of the 81, calculation of 3D-LVEF was achieved in 49% (n = 40), GLS in 90% (n = 73), and 2D LVEF in 100% (n = 81). Strong correlation existed between 2D LVEF and 3D LVEF (r = 0.94, p < 0.0001). Bland-Altman plot showed that mean differences between 2D-LVEF and 3D-LVEF were consistent throughout a range of values. For patients with adequate image quality, the most persistent obstacle to 3D-LVEF acquisition was poor endocardial border tracking (n = 22, 54%). Conclusion This study demonstrates the high feasibility of 2D-GLS and 2D LVEF, even in those with challenging echocardiographic windows. The lower feasibility of 3D LVEF limits its real-world clinical application, even though only a small difference in agreement with 2D LVEF calculation was found.